Dosage form for hormonal contraception

ABSTRACT

The present invention relates to a dosage form for hormonal contraception containing a given number of hormone-containing daily units and a given number of hormone-free daily units for daily, oral administration, characterised in that the hormone-containing daily units each contain at most the minimum effective daily amount of folic acid for women and the hormone-free daily units contain at least a multiple of this amount up to the maximum permissible amount of folic acid for women.

The present invention relates to a dosage form for hormonal contraception containing a given number of hormone-containing daily units and a given number of hormone-free daily units for uninterrupted daily oral administration to women, characterised in that the hormone-containing daily units contain folic acid in a daily amount of at most 200 μg and the hormone-free daily units in each case contain folic acid in a daily amount of >200 μg up to the maximum permissible amount of folic acid for women.

It is suspected that long-term taking of gestagen-based hormonal contraceptives may lead to a deficiency of folic acid. This deficiency may lead to cardiovascular diseases, for example.

It is also known that if pregnancy occurs a short time after stopping taking such hormonal contraceptives, there is a risk that the deficiency of folic acid may lead to neural tube defects in the embryo. Since the neural tube develops in the first weeks of pregnancy, it is particularly advantageous to ensure that folic acid is taken prior to conception.

If, therefore, a woman stops taking hormonal contraceptives because she wants to have a child and she falls pregnant in the first cycle after stopping the hormonal contraceptives, it is particularly important to ensure an appropriately high level of folic acid in the period directly after stopping taking the “Pill”, as hormonal contraceptives are known.

There is therefore a need to add folic acid to hormonal contraceptives in such a way that the added folic acid is adapted to a woman's varying needs over the period during and after a tablet-taking cycle.

The combination of hormonal contraceptives and folic acid is already known from WO 99/53910. The amount of folic acid per daily dose of hormones merely matches the changes in a woman's folic acid requirements as she ages, and does not take account of the changes in folic acid requirements over a contraceptive-taking cycle.

It was therefore the object of the present invention to provide a dosage form for hormonal contraception which takes account of the changes in folic acid requirements during a hormone-taking cycle and subsequent hormone-free daily units.

This object was achieved by providing the dosage form according to the invention for hormonal contraception containing a given number of hormone-containing daily units and a given number of hormone-free daily units for uninterrupted daily oral administration to women, characterised in that the hormone-containing daily units contain folic acid in a daily amount of at most 200 μg and the hormone-free daily units in each case contain folic acid in a daily amount of >200 μg up to the maximum permissible amount for women of folic acid.

Women of child-bearing age have a daily folic acid requirement which may be adequately met by a healthy diet. Long term taking of hormonal contraceptives containing gestagens may lead to an additional folic acid requirement, which may likewise be met by a healthy diet. However, it is advisable to provide women with a daily dose of the minimum effective daily amount of folic acid.

Accordingly, hormone-containing daily units of the dosage form according to the invention may each comprise a daily amount of folic acid corresponding to this minimum effective daily amount of folic acid. Preferably, the hormone-containing daily units of the dosage form according to the invention contain 0 to 200 μg of folic acid, particularly preferably 5 to 200 μg of folic acid.

The hormone-containing daily units of the dosage form according to the invention may also not contain any additional folic acid, however.

To ensure that a woman consumes the necessary amount of folic acid or that her increased folic acid requirement at least at the beginning of pregnancy is met as quickly as possible if she decides to try for a baby, so avoiding possible damage to the embryo due to a folic acid deficiency, the hormone-free daily units of the folic acid dosage form according to the invention contain folic acid in an amount of more than 200 μg up to the maximum permissible daily amount of folic acid for women, preferably up to 5 mg of folic acid per daily unit, particularly preferably of more than 200 μg to 5 mg folic acid, very particularly preferably up to the maximum permissible daily amount of folic acid for women of reproductive age.

By adding folic acid to the hormone-free daily units of the dosage form according to the invention in amounts of up to the maximum permissible amount, it is possible to increase the folic acid concentration in a woman's body while she is taking the hormone-free daily units to the extent that the her body's increased folic acid requirement is met as quickly as possible if she stops taking a hormone-containing contraceptive and then falls pregnant.

The hormone-containing daily units of the dosage form according to the invention preferably each contain the same amount of folic acid. This also applies to the hormone-free daily units, which likewise each contain the same amount of folic acid, this being greater than the amount contained in the hormone-containing daily units however.

The folic acid may also be present in the dosage form according to the invention as a pharmaceutically safe salt, preferably as sodium, potassium or magnesium salt, or as a corresponding derivative.

Suitable derivatives of folic acid are mono- or diesters, wherein the diesters may be differently or identically esterified. Suitable ester groups are preferably C₁-C₈ low alkyl groups, such as methyl, ethyl, propyl or butyl, branched C₁-C₈ low alkyl groups, such as isopropyl, isobutyl or sec.-butyl, cycloalkyl groups, such as cyclopentyl or cyclohexyl, aryl groups, such as phenyl or substituted phenyl with 1-2 substituents, such as low alkyl or haloalkoxyl groups, or arylalkyl groups with C₁-C₈ alkyl and aryl groups, such as phenyl or substituted phenyl.

In addition, the hormone-free daily units and optionally the hormone-containing daily units may contain further vitamins or minerals in addition to the folic acid.

The number of daily units of a dosage form according to the invention may correspond to a natural, monthly menstrual cycle. In this case, the dosage form according to the invention contains 21 to 25 hormone-containing daily units and 7 to 3 hormone-free daily units.

However, it is also possible for the total number of hormone-containing daily units to correspond to more than a woman's natural monthly cycle, such that a dosage form according to the invention may contain hormone-containing daily units to be taken without interruption for up to 2 years, preferably up to 1 year, and 7 to 3 hormone-free daily units. However, it is also possible for the dosage form according to the invention to comprise 42 to 52 or 77 to 193 hormone-containing daily units alongside 7 to 3 hormone-free daily units.

The hormone-containing daily units of the dosage form according to the invention may each contain at least one contraceptively acting hormone component, preferably a combination of hormone components such as an oestrogen and a gestagen.

Oestrogens which are suitable for the hormone-containing daily units of the dosage form according to the invention are preferably selected from the group comprising oestradiol, oestradiol valerate, ethinyloestradiol and mestranol. Ethinyloestradiol is particularly preferred as the oestrogen for the dosage form according to the invention.

Gestagens which are suitable for the hormone-containing daily units of the dosage form according to the invention are preferably selected from the group comprising norethisterone, norethisterone acetate, norethisterone enantate, norgestimate, norgestrel, levonorgestrel, gestodene, hydroxyprogesterone caproate, medroxyprogesterone acetate, megestrol acetate, chlormadinone acetate, lynestrenol, cyproterone acetate, drospirenone, dienogest, desogestrel, progesterone, dydrogesterone, medrogestone, ethynodiol, promegestone, nomegestrol acetate and trimegestone.

The hormones are preferably used in the amounts stated below. Oestrogens: Oestradiol, oestradiol valerate 0.5 to 4 mg Ethinyloestradiol 5 to 50 μg Mestranol 8 to 70 μg

Gestagens: Norethisterone, norethisterone acetate 0.5 to 1.0 mg Norgestimate 0.1 to 0.25 mg Norgestrel 0.3 to 1.0 mg Levonorgestrel 0.05 to 0.15 mg Gestodene 0.05 to 0.12 mg Hydroxyprogesterone caproate 10 to 800 mg Medroxyprogesterone acetate 2.5 to 40 mg Megestrol acetate 1.0 to 10 mg Chlormadinone acetate 0.5 to 10 mg Lynestrenol 0.4 to 3 mg Cyproterone acetate 0.5 to 10 mg Drospirenone 1.0 to 10 mg Dienogest 1.0 to 10 mg Desogestrel 0.06 to 0.30 mg Progesterone 100 to 1000 mg Dydrogesterone 5 to 50 mg Medrogestone 2 to 30 mg Ethynodiol, ethynodiol diacetate 0.4 to 3 mg Promegestone 0.5 to 10 mg Nomegestrol acetate 0.5 to 10 mg Trimegestone 1 to 10 mg Etonogestrel 0.1 to 1 mg Norelgestromin 0.1 to 2 mg Norethynodrel 0.3 to 3 mg Tibolone 1 to 10 mg

The dosage forms according to the invention, especially the hormone-containing daily units, preferably comprise the following hormone combinations:

-   -   1. 0.015 mg ethinyloestradiol+0.06 mg gestodene     -   2. 0.02 mg ethinyloestradiol+0.15 mg desogestrel     -   3. 0.02 mg ethinyloestradiol+0.5 mg norethisterone     -   4. 0.02 mg ethinyloestradiol+1 mg chlormadinone acetate or 2 mg         or 3 mg chlormadinone acetate     -   5. 0.02 mg ethinyloestradiol+1 mg norethisterone     -   6. 0.03 mg ethinyloestradiol+1 mg norethisterone     -   7. 0.02 mg ethinyloestradiol+4 mg chlormadinone acetate     -   8. 0.02 mg ethinyloestradiol+5 mg chlormadinone acetate     -   9. 0.02 mg ethinyloestradiol+0.1 mg levonorgestrel     -   10. 0.02 mg ethinyloestradiol+0.15 mg desogestrel     -   11. 0.02 mg ethinyloestradiol+0.1 mg levonorgestrel     -   12. 0.03 mg ethinyloestradiol+3 mg drospirenone     -   13. 0.02 mg ethinyloestradiol+3 mg drospirenone     -   14. 0.03 mg ethinyloestradiol+2 mg chlormadinone acetate     -   15. 0.035 mg ethinyloestradiol+0.25 mg norgestimate     -   16. 0.03 mg ethinyloestradiol+0.5 mg norethisterone     -   17. 0.03 mg ethinyloestradiol+0.15 mg desogestrel     -   18. 0.03 mg ethinyloestradiol+0.075 mg gestodene     -   19. 0.03 mg ethinyloestradiol+0.15 mg levonorgestrel     -   20. 0.03 mg ethinyloestradiol+0.15 mg desogestrel     -   21. 0.03 mg ethinyloestradiol+0.15 mg levonorgestrel     -   22. 0.03 mg ethinyloestradiol+0.125 mg levonorgestrel     -   23. 0.0375 mg ethinyloestradiol+0.75 mg lynestrenol     -   24. 0.03 mg ethinyloestradiol+1 mg norethisterone     -   25. 0.03 mg ethinyloestradiol+0.5 mg norethisterone     -   26. 0.03 mg ethinyloestradiol+0.15 mg levonorgestrel     -   27. 0.04 mg ethinyloestradiol+2 mg lynestrenol     -   28. 1 st phase=7 days         -   0.050 mg desogestrel+0.035 ethinyloestradiol         -   2nd phase=7 days         -   0.100 mg desogestrel+0.030 ethinyloestradiol         -   3rd phase=7 days         -   0.150 mg desogestrel+0.030 ethinyloestradiol     -   29. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=10 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   30. 1 st phase=7 days         -   0.035 mg EE+0.180 mg norgestimate         -   2nd phase=7 days         -   0.035 mg EE+0.215 mg norgestimate         -   3rd phase=7 days         -   0.035 mg EE+0.250 mg norgestimate     -   31. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=10 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   32. 1 st phase=7 days         -   0.035 mg EE+0.5 mg norethisterone         -   2nd phase=9 days         -   0.035 mg EE+1 mg norethisterone         -   3rd phase=5 days         -   0.035 mg EE+0.5 mg norethisterone     -   33. 1st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=10 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   34. 1 st phase=7 days         -   0.035 mg EE+0.5 mg norethisterone         -   2nd phase=7 days         -   0.035 mg EE+0.75 mg norethisterone         -   3rd phase=7 days         -   0.035 mg EE+1 mg norethisterone     -   35. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=10 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   36. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=6 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=9 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   37. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.05 mg EE+0.05 mg levonorgestrel         -   3rd phase=10 days         -   0.04 mg EE+0.125 mg levonorgestrel     -   38. 1 st phase=6 days         -   0.03 mg EE+0.05 mg levonorgestrel         -   2nd phase=5 days         -   0.04 mg EE+0.075 mg levonorgestrel         -   3rd phase=10 days         -   0.03 mg EE+0.125 mg levonorgestrel     -   39. 0.035 mg ethinyloestradiol+2 mg cyproterone acetate     -   40. 0.05 mg mestranol+2 mg chlormadinone acetate     -   41. 1 st phase=11 days         -   0.05 mg ethinyloestradiol+1 mg chlormadinone acetate         -   2nd phase=11 days         -   0.05 mg ethinyloestradiol+2 mg chlormadinone acetate     -   42. 0.08 mg mestranol+2 mg chlormadinone acetate     -   43. 0.03 mg ethinyloestradiol+2 mg dienogest     -   44. 0.05 mg ethinyloestradiol+0.5 mg norgestrel     -   45. 0.05 mg ethinyloestradiol+0.125 mg levonorgestrel     -   46. 0.05 mg ethinyloestradiol+0.25 mg levonorgestrel     -   47. 0.05 mg ethinyloestradiol+0.125 mg levonorgestrel     -   48. 0.05 mg ethinyloestradiol+1 mg norethisterone acetate     -   49. 0.05 mg ethinyloestradiol+0.25 mg levonorgestrel     -   50. 1 st phase=7 days         -   0.04 mg ethinyloestradiol+0.025 mg desogestrel         -   2nd phase=15 days         -   0.03 mg ethinyloestradiol+0.125 mg desogestrel     -   51. 1 st phase=11 days         -   0.05 mg ethinyloestradiol+0.05 mg levonorgestrel         -   2nd phase=10 days         -   0.05 mg ethinyloestradiol+0.125 mg levonorgestrel     -   52. 1 st phase=11 days         -   0.05 mg ethinyloestradiol+0.05 mg levonorgestrel         -   2nd phase=10 days         -   0.05 mg ethinyloestradiol+0.125 mg levonorgestrel     -   53. 1 st phase=7 days         -   0.05 mg ethinyloestradiol+2nd phase=15 days         -   0.05 mg ethinyloestradiol+2.5 mg lynestrenol     -   54. 1 st phase=7 days         -   0.05 mg ethinyloestradiol+2nd phase=15 days         -   0.05 mg ethinyloestradiol+0.125 mg desogestrel     -   55. 1 st phase=6 days         -   0.05 mg ethinyloestradiol+2nd phase=15 days         -   0.05 mg ethinyloestradiol+1 mg norethisterone acetate

Where the dosage form according to the invention provides a multiphasic hormone combination, it is recommended that the hormone-containing daily units be taken without interruption only for a period of 21 to 25 days, followed by 7 to 3 days of taking hormone-free daily units.

The dosage form according to the invention preferably comprises at least 21, preferably 21 to 25, hormone-containing daily units which preferably include 5 to 30 μg of ethinyloestradiol and 0.5 to 5 mg of chlormadinone acetate, and 3 to 7 hormone-free daily units. However, the dosage form according to the invention may also comprise hormone-containing daily units for several years, preferably of 42 to 365 units, which contain the stated hormone combination in the stated ranges, wherein the corresponding uninterrupted tablet-taking periods are followed by 7 to 3 hormone-free daily units with an elevated amount of folic acid stated according to the invention.

As already stated, the hormone-containing daily units of the dosage form according to the invention may take the form of a monophasic (one-phase) or multiphasic contraceptive. In the case of a multiphasic contraceptive, a two-phase or a three-phase pill may be present, which is not usually suitable, however, to be taken for a period longer than a woman's natural cycle.

The dosage form according to the invention may also be a constituent of a kit, wherein the kit according to the invention may comprise a plurality of the dosage forms according to the invention, especially if one dosage form comprises only one monthly cycle. The kit may optionally include a calendar or a diary. 

1. A dosage form for hormonal contraception containing a given number of hormone-containing daily units and a given number of hormone-free daily units for uninterrupted daily oral administration to women, characterised in that the hormone-containing daily units contain folic acid in a daily amount of at most 200 μg and the hormone-free daily units in each case contain folic acid in a daily amount of >200 μg up to the maximum permissible amount for women of folic acid:
 2. A dosage form according to claim 1, characterised in that the hormone-containing daily units each contain 5 to 200 μg of folic acid.
 3. A dosage form according to claim 1, characterised in that the hormone-containing daily units do not contain any folic acid.
 4. A dosage form according to claim 1, characterised in that the hormone-containing daily units contain folic acid in an amount up to the minimum effective daily amount for women.
 5. A dosage form according to claim 1, characterised in that the hormone-free daily units each contain more than 200 μg and up to 5 mg.
 6. A dosage form according to claim 1, characterised in that the hormone-containing daily units each contain the same amount of folic acid and the hormone-free daily units likewise each contain the same amount of folic acid.
 7. A dosage form according to claim 1, characterised in that it comprises at least 21 hormone-containing daily units and 7 to 3 hormone-free daily units.
 8. A dosage form according to claim 7, characterised in that its maximum number of hormone-containing daily units is sufficient for administration for several years, preferably for 2 years, particularly preferably for 1 year, and the number of hormone-free daily units corresponds to 7 to 3 days.
 9. A dosage form according to claim 7, characterised in that it comprises up to 730, preferably up to 365, hormone-containing daily units and 7 to 3 hormone-free daily units.
 10. A dosage form according to claim 7, characterised in that it comprises 21 to 25 hormone-containing daily units and 7 to 3 hormone-free daily units.
 11. A dosage form according to claim 7, characterised in that it comprises 42 to 52 hormone-containing daily units and 7 to 3 hormone-free daily units.
 12. A dosage form according to claim 7, characterised in that it comprises 77 to 193 hormone-containing daily units and 7 to 3 hormone-free daily units.
 13. A dosage form according to claim 1, characterised in that the hormone-containing daily units each contain at least one contraceptively active hormone component, preferably a combination of hormone components, particularly preferably a combination of an oestrogen and a gestagen.
 14. A dosage form according to claim 1, characterised in that the number of hormone-containing daily units corresponds to a monophasic contraceptive.
 15. A kit containing at least one dosage form for hormonal contraception according to claim
 1. 16. A kit according to claim 15, characterised in that it contains a plurality of dosage forms according to claim 1 any one of
 1. 